Ch. 18 prepU MC
A nurse is interviewing a client and suspects that the client may have narcissistic personality disorder. Which statement by the client would help support the nurse's suspicions? "I have a very important position in life; everyone I know wants to be like me." "My spouse is poisoning my food to get rid of me and marry my spouse's boss." "I like to work alone because then I can let my thoughts wander." "I'm always the life of the party, making new friends all the time."
"I have a very important position in life; everyone I know wants to be like me."
A nurse is assessing a client and suspects that the client may have obsessive-compulsive personality disorder based on which statement? "I need to have everything perfect. My life is organized down to the second." "I don't have any friends and I don't like to do anything socially." "I can't trust anybody that I meet, no matter where it is or who they are." "I am better than everyone and they should emulate me."
"I need to have everything perfect. My life is organized down to the second."
A psychiatric nurse is providing care to a client with borderline personality disorder. The nurse implements strategies when the client is frustrated and stressed to help control which emotion? Anger Depression Anxiety Shyness
Anger
A nurse is describing histrionic personality disorder to a group of new nurses. Which term would the nurse most likely use? Attention seeking Psychopath Sociopath Lacking empathy
Attention seeking
Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis? Depression Schizophrenia Posttraumatic stress disorder Borderline personality disorder
Borderline personality disorder
A 70-year-old client comes to the clinic with the client's daughter for group therapy. The client wants the daughter to do everything with the client, is afraid to be left alone, and is having difficulty making any individual decisions. Interventions for this client would center around the diagnosis of which personality disorder? Narcissistic Dependent Antisocial Schizoid
Dependent
The client is a 29-year-old who is having a great deal of difficulty with a new job. The client has been unable to make decisions individually and feels overwhelmed when the client needs to begin a new project. The client often relies on one of her coworkers to help with decisions and projects. Which would describe the client correctly? Narcissistic personality Dependent personality Schizotypal personality Histrionic personality
Dependent personality
The nurse in charge of an inpatient psychiatric unit is frustrated and angry with a client who has borderline personality disorder. Which steps should the nurse take? Confront the client firmly but compassionately about how the client's behavior makes the nurse feel. Direct the client to another staff member when the client tries to interact. Examine the nurse's own feelings to discover the source of the nurse's anger. Ignore the feelings and move on from the client.
Examine the nurse's own feelings to discover the source of the nurse's anger.
After teaching a group of nurses about problems commonly experienced by clients with borderline personality disorder (BPD), the nurse determines that additional teaching is needed when the group identifies which problem? Maintaining intimate relationships Having exaggerated self-esteem Keeping a job Living within the law
Having exaggerated self-esteem
Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what? Problem solving Impulsive behaviors Physical disability Psychotic behaviors
Impulsive behaviors
When documenting observations of the behaviors exhibited by a client diagnosed with borderline personality disorder, the nurse can correctly use which terms? Impulsive, self-destructive, unstable Impulsive, aggressive, and manipulative Perfectionistic, rigid, and controlling Emotional, dramatic, and theatrical
Impulsive, self-destructive, unstable
Which of the following personality characteristics is most likely to predispose an individual to medication abuse? Low self-esteem Desire to inflict pain upon oneself Passive-aggressive personality disorder Histrionic personality disorder
Low self-esteem
A nurse caring for a client with borderline personality disorder (BPD) consistently informs the client of the length of the relationship and routinely prepares the client for termination and the end of hospitalization. Which is the nurse trying to prevent? Poor social skills Depression Mania Maladaptive expression of emotions
Maladaptive expression of emotions
A client with borderline personality disorder has been admitted to the inpatient unit after being found in the client's parents' bedroom, burning the client's arm with an iron. This injury required a brief stay in the hospital's burn unit prior to transfer to your psychiatric unit. Which is the nursing care priority for this client during the first 24 hours of admission? Suicidal assessment Working on self-esteem Impulse control Protection from self-mutilation
Protection from self-mutilation
The nurse is admitting a client with histrionic personality disorder to the inpatient unit. The nurse would anticipate that this client may exhibit which behavior? Manipulation Distrust Perfection Self-dramatization
Self-dramatization
As part of a client's treatment plan for borderline personality disorder, the client is engaged in dialectical behavior therapy. As part of the therapy, the client is learning how to control and change behavior in response to events. The nurse identifies the client as learning which type of skills? Emotion regulation skills Mindfulness skills Distress tolerance skills Self-management skills
Self-management skills
A group of nursing students is reviewing information about antisocial personality disorder. The students demonstrate understanding of this disorder when they state what? The disorder occurs more frequently in women. The individual must be at least 18 years of age. The disorder is found primarily in Asian individuals. Alcohol abuse disorder rarely accompanies this disorder.
The individual must be at least 18 years of age.
Which personality disorder is characterized by an alteration between hostile self-assertion, such as stubbornness, and excessive dependence? Dependent Histrionic Narcissistic Passive-aggressive
Passive-aggressive
After educating a group of nursing students on comorbidities associated with borderline personality disorder, the instructor determines a need for additional education when the students identify which of the following as a common comorbid condition? Mood disorder Substance abuse disorder Eating disorder Schizophrenia
Schizophrenia
Which of the following occurs when self-definition is poorly developed? Identity diffusion Affective instability Dichotomous thinking Dissociation
Identity diffusion
A client is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations? Paranoid thoughts Perfectionism Trusting behaviors Dependency needs
Paranoid thoughts
A psychiatric-mental health nurse is reviewing information about the possible theories associated with narcissistic personality disorder. The nurse demonstrates understanding of the information by identifying which concept as being associated with the development of this personality disorder? Deficiency of serotonin and dopamine Alteration in brain structures Parental overindulgence of a child Complete emotional separation from a caregiver
Parental overindulgence of a child
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? Risk for self-mutilation Ineffective coping Disturbed thought process Chronic low self-esteem
Risk for self-mutilation
A client with paranoid personality disorder is admitted to a psychiatric facility. Which statement by the nurse would best establish rapport and encourage the client to confide in the nurse? "It bothers me when I think people are talking about me." "It's normal not to trust anyone." "I know how you feel. I'd feel the same way in your situation." "I get upset once in a while, too."
"I get upset once in a while, too."
Treatment approaches for clients with personality disorders generally rely on which modality? Pharmacotherapy Cognitive-behavioral therapy Individual therapy A combination of approaches
A combination of approaches
When teaching a client with antisocial personality disorder (ASPD), which approach would be most appropriate for the nurse to use? Direct Lecture Challenging Confrontational
Direct
When conducting a social history with a client diagnosed with a borderline personality disorder (BPD), which question would be most important to ask the client related to impulsivity? "Do you think of yourself as physically attractive?" "Are you pleased with your medications?" "Do you always practice safe sex?" "Are you interested in making your partner happy?"
"Do you always practice safe sex?"
A nursing instructor is teaching about using behavioral interventions when caring for clients with borderline personality disorder. Which statement by a student indicates a need for further instruction? "Sometimes it is best to confront a client about irritating behaviors." "In some instances, negative responses can be viewed as positive reinforcement." "Grossly disrespectful behaviors are better ignored." "Sometimes it is best to just ignore a client's irritating behaviors."
"Grossly disrespectful behaviors are better ignored."
A 17-year-old client comes to the community crisis clinic with multiple superficial cuts on the wrist. The client is crying uncontrollably and states that the client's romantic partner has left and the client doesn't want to live without the partner. What would be the most therapeutic initial nursing response? "Many partners change their minds about relationships, this is really quite normal." "There's plenty of fish in the sea. Don't worry, at your age you will find someone else." "Let's set some boundaries on your behavior here." "I can see that you are feeling anxious. I will stay with you until you feel better."
"I can see that you are feeling anxious. I will stay with you until you feel better."
A client with borderline personality disorder starts flirting with the nurse, saying the client dreams about the nurse at night and wants to kiss the nurse. What would be the best response by the nurse? "That is very sweet of you to say." "I feel uncomfortable with what you said. My role is to support you in recovery." "I feel flattered that you think that much of me, but nurses don't date clients." "Let's talk about something else now."
"I feel uncomfortable with what you said. My role is to support you in recovery."
The nurse is assessing a client who is diagnosed with borderline personality disorder. Which client statement indicates the client is at risk for self-injurious behavior? "I have felt so down lately. I don't enjoy doing anything anymore." "I do what I do because others tell me to do so." "When I feel extremely anxious, it is like my mind goes somewhere else." "It is almost as if as soon as I think of doing something, I immediately do it."
"I have felt so down lately. I don't enjoy doing anything anymore."
A 43-year-old female client is observed walking and dancing around the unit dressed in red high heels and a provocative style of dress. The client is seen sitting on the lap of a male client on the unit, and they are laughing. Which is the most therapeutic nursing intervention? "Why are you sitting on the nurse's lap?" "You need to go to your room because you are engaging in sexually provocative behavior again!" "I need for you to get off his lap, this behavior is not appropriate." "Why don't we go play a game of ping-pong?"
"I need for you to get off his lap, this behavior is not appropriate."
A nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when stating what? "I should start by stating my feelings as an 'I' statement." "Maybe I should start by describing the situation that has me upset." "I should first tell the other person what I'd like to be different about the situation." "I should begin by telling the other person what has triggered my emotion."
"I should start by stating my feelings as an 'I' statement."
A nurse is developing a nurse-client relationship with a client diagnosed with borderline personality disorder (BPD). Which statement by the nurse demonstrates that the nurse understands the client's fears of abandonment and intimacy? "I'm here to help you for as long as I can." "I will be seeing you during the daytime this week." "We will work on things until your physician says you can go home." "Let's see how things go first and then how long you need me."
"I will be seeing you during the daytime this week."
The adult children of a client with narcissistic personality disorder meet with the therapist as part of their parent's treatment. The nurse is aware that which statement by the daughter is consistent with behavior typically associated with this personality disorder? "My parent was always timid and fearful." "My parent never had any family or friends over to the house." "My parent was constantly threatening to commit suicide." "My parent never really seemed to see me as a person with my own thoughts and problems."
"My parent never really seemed to see me as a person with my own thoughts and problems."
A client comes to the clinic for a follow-up visit. Despite being warm and friendly with the nurse on a previous visit, today the client presents with anger and sarcastic undertones with the same nurse. The client is presenting which behavior commonly seen in borderline personality disorder? Identity diffusion Depression Affective instability Dichotomous thinking
Affective instability
A client asks the nurse to go to lunch with the client one day next week after the client is discharged. Which statement is the most therapeutic response? "My role here is to help you recover. Let's talk about what else you can be doing after discharge." "That sounds good. Call the unit when you decide which day, and we can set it up." "I'd love to do that, but I'm on vacation next week." "I'm sorry, it is not within my role to have any affiliation with you after your discharge."
"My role here is to help you recover. Let's talk about what else you can be doing after discharge."
A mental health nurse is working with a client with antisocial personality disorder. The nurse has just reviewed the unit rule of one cigarette per break. While telling the client about the unit rules, the client asks, "Well, if I have not done anything bad all day, can I have two cigarettes instead of one?" Which would be the most therapeutic nursing response? "Well, that's a good question. I need to check with the team." "No, only one cigarette is allowed per break time." "This is a good example of trying to push your limits." "It depends on whether or not we can make that exception that day."
"No, only one cigarette is allowed per break time."
A client with borderline personality disorder has been admitted to the inpatient unit because the client has been engaging in wrist cutting. The client's sibling is visiting, and the sibling asks the nurse to explain why the client sometimes does this. Which response by the nurse would be most appropriate? "Sometimes the self-injurious behavior is undertaken to relieve stress." "Self-injurious behavior often calms and sedates people with this diagnosis." "Sometimes they do it to avoid the onslaught of delusional thinking." "The self-mutilation often slows the mood swings your sibling experiences."
"Sometimes the self-injurious behavior is undertaken to relieve stress."
Which statement by a client with borderline personality disorder (BPD) is an example of catastrophizing? "This is the most awful thing that has ever happened to me." "No one ever listens to me." "I never get what I want." "If I had not made him mad, he wouldn't have hit me."
"This is the most awful thing that has ever happened to me."
A client with borderline personality disorder tells a nurse, "I'm afraid to get on a train because we'll probably get into a wreck." Which response by the nurse would be most appropriate? "What are the chances of that actually happening?" "Now you know that won't happen." "Have you had a bad experience riding a train?" "Have you thought about going by automobile?"
"What are the chances of that actually happening?"
A client with antisocial personality disorder is begging to use the phone to call the client's spouse, even though it is against the unit rules. The client begs, "It is just this once, and my spouse will be so hurt if I don't call." Which would be the most appropriate response by the nurse? "Only to help your spouse, you can call this time." "I will get in trouble with my supervisor if I let you call." "You may not use the phone to call your spouse." "You cannot call because you need to focus on your recovery while you are here, not your spouse."
"You may not use the phone to call your spouse."
The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client? "You'll be expected to attend group therapy each day." "I and other members of the health care team would like you to attend group therapy each day." "You'll find your condition will improve much faster if you attend group therapy each day." "Please try to attend group therapy each day."
"You'll be expected to attend group therapy each day."
A client who has a diagnosis of histrionic personality disorder is admitted to an inpatient mental health unit. The client leaves the unit briefly without notifying the nurse or other members of the health care team. The client's nurse uses confrontation to remind the client of the rules of coming and going from the unit. The client has responded, "But those rules are more for the schizophrenics and crazy people, right?" How should the nurse respond? "Your safety is the priority while you are admitted to this unit. Please ensure you notify your nurse prior to leaving." "Even though there's no real safety risk in your case, I'd appreciate it if you tried to remember next time." "What would make you think that? You're supposed to behave the same as anyone else here." "If you want an exemption, I can ask the psychiatrist but there are no guarantees."
"Your safety is the priority while you are admitted to this unit. Please ensure you notify your nurse prior to leaving."
A nurse is reviewing the medical record of a female client diagnosed with borderline personality disorder (BPD). Which would the nurse identify as one of the strongest risk factors for this disorder? Abuse as a child Parental alcohol abuse Poverty History of depression
Abuse as a child
After teaching a group of nurses about borderline personality disorder, the leader determines that the education was successful when the group identifies that symptoms typically begin in which age group? Adolescence Young adulthood Middle-age individuals Late adulthood
Adolescence
Which diagnosis is associated with a pervasive disregard for and violation of the rights of others? Antisocial personality Borderline personality Passive-aggressive personality Schizoid personality
Antisocial personality
The nurse is interviewing a client with a history of violence. The client boasts that the client "put a kid in a wheelchair" once when the client was younger and has maimed others. The client states, "Who cares? Life's tough." Violence and insensitivity are associated with which personality disorder? Schizoid personality disorder Antisocial personality disorder Histrionic personality disorder Borderline personality disorder
Antisocial personality disorder
Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by what? Odd or eccentric behaviors Dramatic or erratic behaviors Anxious or fearful behaviors Manic or withdrawn behaviors
Anxious or fearful behaviors
A client has a diagnosis of borderline personality disorder and lives at home with the client's parents. The client has been in the psychiatric unit for 2 weeks and is scheduled to be discharged tomorrow. Which would be most therapeutic when the client's parents come in to discuss discharge plans? Attempt to discuss placing the client into an assisted living environment Ask the parents how they have coped with the client's behaviors over the years Ask the parents to keep a written schedule of activities for each day for the client Encourage the parents to discuss the possibility of the client going into a day-care program when the client goes home
Ask the parents to keep a written schedule of activities for each day for the client
A nurse is providing care to a client with borderline personality disorder. When providing for the client's biopsychosocial needs, the nurse would address which in the biologic domain? Establishing a therapeutic relationship Establishing boundaries Assisting with problem solving Assisting with sleep measures
Assisting with sleep measures
A mental health nurse is planning a psychotherapy group for clients with personality disorders. The nurse knows the group will be comprised of a significant number of clients from Arab and Asian ethnicity. Which should the nurse consider when planning this group? Be cautious to treat both populations with respect to their culturally driven health care preferences. Ensure cultural sensitivity when discussing client problems with their family members Expect that most people of Arab descent will have posttraumatic stress. Be aware of the how each client's personality has been affected by his or her cultures values and beliefs.
Be aware of the how each client's personality has been affected by his or her cultures values and beliefs.
Which personality disorder is most often treated within the inpatient psychiatric setting? Antisocial Borderline Dependent Schizotypal
Borderline
A 30-year-old client who has not paid rent in 4 months is being evicted from an apartment. The client is brought to the hospital after the client uses a kitchen knife to cut the client's wrist in response to the stress of the eviction. The client's behavior is consistent with what? Paranoid personality disorder Borderline personality disorder Schizotypal personality disorder Antisocial personality disorder
Borderline personality disorder
A client is admitted to the mental health unit after the client's spouse brings the client to the emergency department. Upon arrival, the spouse explained that the client had been crying all weekend and stating that the client wanted to die. Upon further assessment, the spouse reports that the client always has difficulty controlling anger and frequently worries that the spouse will leave the client. Recently, the client has been getting drunk every night, which the client never used to do. What diagnosis should the nurse suspect applies to this client? Bipolar disorder Borderline personality disorder Depression Mania
Borderline personality disorder
The nurse is in the process of planning the care of a psychiatric-mental health client and has specified the following outcome: The client will be free from self-inflicted harm. What is this client's most likely diagnosis? Dependent personality disorder Borderline personality disorder Antisocial personality disorder Schizoid personality disorder
Borderline personality disorder
A personality disorder is defined as a collection of traits that do what? Cause behavioral dysfunction and inner distress Are malleable and poorly defined Lead to aggression and violence Lead to withdrawn and antisocial behavior
Cause behavioral dysfunction and inner distress
A nurse is assessing a client with borderline personality disorder. During the assessment the nurse notes that the client is using projective identification. Which of the following would support this interpretation? Client attributes own feelings falsely to others. Client lacks a definitive sense of self Client misinterprets environmental stimuli Client is unable to control emotional reactions in social situations
Client attributes own feelings falsely to others.
Into which personality disorder category are individuals placed whose behavior appears odd or eccentric? Cluster A Cluster B Cluster C Cluster D
Cluster A
Which cluster of personality disorders is represented by individuals who appear anxious or fearful? Cluster A Cluster B Cluster C Cluster D
Cluster C
The nurse is conducting an admission assessment of a 41-year-old client. Each time that the nurse asks the client a question, the client defers to the client's spouse to answer the question. Such behavior is consistent with which personality disorder? Borderline personality disorder Histrionic personality disorder Dependent personality disorder Antisocial personality disorder
Dependent personality disorder
A nurse is conducting a mental status exam of a client with borderline personality disorder (BPD). The client verbalizes statements that demonstrate a view of things as absolute, with no perception of compromise. The nurse interprets this type of thinking, documenting it as which of the following? Dichotomous Abstract Irrational Disorganized
Dichotomous
Based on psychological theories, which is believed to be critical to understanding personality disorders? Functional attachments Chaotic families Abuse Difficult temperament
Difficult temperament
The nurse in charge of an inpatient psychiatric unit is irritated with a client who has borderline personality disorder. Which step should the nurse take? Confront the client firmly about how the client's behavior makes the nurse feel. Direct the client to another staff member when the client tries to interact. Discuss the feelings with a colleague to promote coping. Arrange for the client to be transferred to another unit.
Discuss the feelings with a colleague to promote coping.
Which occurs when thinking, feeling, or behaviors occur outside a person's awareness? Affective instability Impulsivity Dissociation Dichotomous thinking
Dissociation
A client diagnosed with schizoid personality disorder is described by family members as what? Eccentric and a loner Dramatic and emotional Nervous and fearful Tired and sad
Eccentric and a loner
A nurse is preparing a teaching plan for a client with antisocial disorder. Which would the nurse most likely employ to promote successful education? Engaging the client in a discussion to direct the topic to the client. Establishing general goals for teaching. Allowing the client to guide the teaching to other topics. Using a lecture approach to provide information.
Engaging the client in a discussion to direct the topic to the client.
Which is considered a part of the social domain of the biopsychosocial interventions for the client diagnosed with borderline personality disorder (BPD)? Medication administration Establishing boundaries Self-harm prevention Nutritional management
Establishing boundaries
Which is a psychosocial explanation for the development of personality disorders? Highly self-directed people reflect uncooperativeness and intolerance. Cooperative people become increasingly helpless over time. Failure to complete a developmental task jeopardizes future personality development. Self-transcendence contributes to self-consciousness and materialism.
Failure to complete a developmental task jeopardizes future personality development.
Brain dysfunction associated with borderline personality disorder (BPD) occurs in the limbic system and which lobe of the brain? Frontal Temporal Parietal Occipital
Frontal
Gambling, binge eating, and engaging in unsafe sex are examples of what? Identity diffusion Dissociation Affective instability Impulsivity
Impulsivity
When providing care to a client who consistently attempts to manipulate the staff, the nurse can best maintain the therapeutic milieu by doing what? Instructing the staff to enforce all unit rules consistently Encouraging questions and discussing the client's concerns Promoting social ostracism of the client's exhibiting manipulation Scheduling staff one-on-one time with the client
Instructing the staff to enforce all unit rules consistently
After reviewing information about different personality disorders, a group of nursing students demonstrates understanding when they identify which as associated with schizoid personality disorder? Introverted Overly friendly Highly social Exuberant
Introverted
A nurse is providing care to a client with antisocial personality disorder. As part of the plan of care, the client is to participate in a problem-solving group. The nurse understands that this intervention is effective based on which rationale? It requires the client to develop attachments. It sets up specific boundaries for the client. It helps to reinforce self-responsibility. It avoids confrontation about dysfunctional patterns.
It helps to reinforce self-responsibility.
The nurse is conducting an education group for women at risk for self-mutilation. What is the most important goal for this group? Learning strategies to refrain from self-harm Learning problem solving Discussing feelings about self-harm Expressing angry feelings
Learning strategies to refrain from self-harm
Which personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy? Narcissistic Histrionic Dependent Obsessive-compulsive
Narcissistic
Which personality disorder is categorized as a Cluster B disorder? Paranoid personality disorder Obsessive-compulsive personality disorder Schizoid personality disorder Narcissistic personality disorder
Narcissistic personality disorder
A nurse is preparing an inservice program for a group of mental health nurses on the topic of borderline personality disorder. When discussing the need for hospitalization, which would the nurse include as the most likely reason for inpatient hospitalization? Dichotomous thinking Identity diffusion Affective instability Nonsuicidal self-injury
Nonsuicidal self-injury
The nurse is assessing a client who has borderline personality disorder. Which would be the priority considering the comorbid conditions associated with this disorder? Somatic complaints Physical functioning Nutrition patterns Personal hygiene practices
Nutrition patterns
A client attends an outpatient mental health clinic accompanied by the client's spouse for an assessment. The client's spouse reports the client is easily irritated if the home is not maintained in a specific order and when the client is unable to complete a "to do" list on time. The client has a serious and formal demeanor. Which personality disorder best describes this client? Narcissistic personality disorder Avoidant personality disorder Paranoid personality disorder Obsessive-compulsive personality disorder
Obsessive-compulsive personality disorder
A client admitted on the inpatient mental health unit has been suspicious of other clients on the unit. This client is often angry at others' comments, and carries a grudge against a roommate for accidentally using the client's bath towel. Which personality disorder is most likely the client's diagnosis? Antisocial Borderline Paranoid Histrionic
Paranoid
A client is a 25-year-old who has a long history of being suspicious of the client's friends and spouse. The client persistently accuses the client's spouse of being unfaithful. The client accuses friends of making statements that are insulting to the client's character. Which is the most accurate description of the client's personality? Schizoid Paranoid Schizotypal Antisocial
Paranoid
A client is diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation? Avoidant Dependent Obsessive-compulsive Paranoid
Paranoid
How does personality disorder differ from personality traits? Personality disorder causes impairment in social and occupational functioning, whereas traits do not. Personality disorder is usually evident earlier in the person's development than are traits. Personality traits usually cause the person a great deal of difficulty but only sporadically. Personality disorder is usually more long term than are traits.
Personality disorder causes impairment in social and occupational functioning, whereas traits do not.
Which statement accurately reflects the prognosis for a client with a personality disorder? Clients make the most improvement with short-term insight-oriented therapy. The prognosis for personality disorders is poor, even with very long-term therapy. Clients with personality disorders have a fairly good prognosis even without therapy. Prognosis varies based on the degree of functional impairment and the client's motivation to change.
Prognosis varies based on the degree of functional impairment and the client's motivation to change.
Which defense mechanism is used by people diagnosed with borderline personality disorder to protect their fragmented self-image? Compensation Projective identification Regression Repression
Projective identification
A nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse identify as a priority? Risk for suicide Risk for other-directed violence Risk for self-injury Risk for self-directed violence
Risk for other-directed violence
Clients with borderline personality disorder (BPD) are usually admitted to the inpatient setting because they exhibit what? Aggression Splitting Self-harm Impulsivity
Self-harm
The most serious consequence of behaviors seen in borderline personality disorder includes what? Identity diffusion Impulsivity Self-injury Dissociation
Self-injury
A client in the emergency department has self-inflicted wounds on both arms. Assessment reveals that the client was diagnosed with borderline personality disorder 6 months ago, for which the client has been receiving outpatient treatment. The client tells the nurse that the client recently found out the client's therapist is moving and will no longer be able to work with the client. What is the priority nursing diagnosis for this client? Self-mutilation Anxiety Stress Loneliness
Self-mutilation
Which of the following interventions should the nurse include in a plan of care for a client with histrionic personality disorder? Accept the client's behavior Assist the client to eliminate passive behavior Set limits on attention-seeking behavior Try to meet the client's needs for attention
Set limits on attention-seeking behavior
A nurse is caring for a client with schizoid personality trait. When developing a plan of care for the client, which would a nurse most likely include? Coping skills training Relaxation techniques Social skills training Anger management training
Social skills training
For clients with borderline personality disorder, there is a tendency to see the world as either good or bad. As a result, these clients use the primitive defense of what? Regression Denial Splitting Compensation
Splitting
When clients diagnosed with borderline personality disorder (BPD) see nurses as either all good or all bad, the client is using which primitive defense? Projective identification Defending Splitting Invalidating
Splitting
Which occurs when a client tends to adore and idealize other people even after a brief acquaintance but then quickly leaves them if these others do not meet the client's expectations in some way? Splitting Thought stopping Decatastrophizing Positive self-talk
Splitting
The nurse is counseling a 28-year-old client with avoidant personality disorder. Despite being employed, the client verbalizes having low quality of life due to anxiety and isolation. Which therapeutic goals does the nurse establish as priority? The client will be able to accept a job promotion. The client will experience increased self-esteem. The client will engage in less risk-taking behavior The client will form a romantic relationship.
The client will experience increased self-esteem.
The nurse is providing care for a client who has been diagnosed with antisocial personality disorder. Which outcome should the nurse prioritize when planning this client's care? The client will establish an adequate balance of rest, sleep, and activity. The client will use the support system without becoming overly dependent on it. The client will to express anger in an adaptive, nonviolent manner The client will be free from self-inflicted harm.
The client will to express anger in an adaptive, nonviolent manner
The nurse-therapist is conducting a group therapy session in which one of the participants is an adult who has been diagnosed with narcissistic personality disorder. The nurse recognizes the significance of childhood experiences in the etiology of personality disorders, which for this client may have included what pattern? The client's parent was in a constant state of crisis and depended heavily on the client for emotional support. The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way. The client's parent was a rigid disciplinarian who demanded complete subservience from both the client and the client's other parent. The client's parents had excessively high performance expectations of the client and failure was met with severe sanctions.
The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way.
A nurse is working with a client diagnosed with antisocial personality disorder. The nurse needs to keep in mind which about the therapeutic relationship? The client continuously focuses on new topics during the relationship. The relationship initially is superficial because of a lack of client commitment. The client uses the relationship to change the problem behavior. The goal is to alleviate dysfunctional thinking.
The relationship initially is superficial because of a lack of client commitment.
Which is a technique used to help the client with borderline personality disorder gain control over self-critical thoughts? Communication triad Affective instability Thought stopping Delay gratification
Thought stopping
Clients with borderline personality disorder (BPD) are usually admitted to an inpatient setting because of what? Splitting Threats of self-harm Agitation Medication noncompliance
Threats of self-harm
A nurse working with a client with borderline personality disorder could establish which as outcome criteria? Display anger more frequently. Act out neediness. Filter concerns and insecurities through the nurse. Tolerate stress without self-mutilation.
Tolerate stress without self-mutilation.
The use of pharmacotherapy in the treatment of personality disorders is optimized if this intervention is what? Used in addition to psychotherapy The primary treatment modality Only minimally effective due to severe side effects Well accepted by the clients
Used in addition to psychotherapy
Which addresses the psychological domain of biopsychosocial interventions for a client with borderline personality disorder? Prevention of self-harm Environmental management Communication skills Withdrawing attention as much as possible
Withdrawing attention as much as possible
A client is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. What finding does the nurse expect the assessment to reveal? acute discomfort in relationships disregard for the rights of others preoccupation with orderliness attention-seeking behaviors
acute discomfort in relationships
When facilitating change in the behavior of a client diagnosed with a personality disorder, the nurse knows which intervention will have the greatest impact on success? collaborating with the client when establishing treatment goals educating the client to the importance of complying with treatment interventions evaluating the client's understanding of the etiology of the prescribed medications conducting regular assessments so the treatment can be changed when necessary
collaborating with the client when establishing treatment goals
The psychiatric nurse expects similar experiences among all clients diagnosed with a Cluster A personality disorder related to ... episodic manic behavior. lack of employable skills. interpersonal relationships. tendency to be distrustful.
interpersonal relationships.
A client who has a history of displaying passive aggressive behavior has a pattern of being late for counseling appointments or cancelling at the last minute. As a result, the counselor has set a limit with the client specifying that the client will forfeit the appointment if the client is more than 5 minutes late for an appointment. Today, the client has come to the counselor's office more than 10 minutes late, at which point the counselor has reminded the client of this limit. Which response would be most consistent with this client's diagnosis? "Whatever. No skin off my back." "I apologize completely and this time I really promise that it will never happen again." "Oh my gosh, I'm so sorry but it totally wasn't my fault because traffic was a complete nightmare." "You're still getting paid for this appointment so what difference does it make?"
"Oh my gosh, I'm so sorry but it totally wasn't my fault because traffic was a complete nightmare."
A nursing instructor is teaching about the importance of bonding and how an easy temperament can serve as a protective factor against psychopathology. Which statement made by a student demonstrates a need for further instruction? "Temperament is malleable." "Temperament is not changeable." "Temperament seen in infancy is often seen later in life." "Temperamental differences among children can be observed very early in life."
"Temperament is not changeable."
A nurse is preparing a presentation for a group of staff nurses on personality disorders. When describing antisocial personality disorders (ASPD), the nurse would explain that for a person to be diagnosed with the disorder, the person must be at least which age? 15 years 18 years 21 years 25 years
18 years
For a person to be diagnosed with antisocial personality disorder, the individual must be a minimum of what age? 7 years 13 years 18 years 21 years
18 years
What does the nurse recognize as the most likely explanation for the self-mutilating behaviors that occur with borderline personality disorder? The result of an inherited disorder that manifests itself as an incapacity to tolerate stress Use of projective identification to reduce anxiety An expression of intense anger or helplessness in order to block emotional pain A constitutional inability to regulate affect that predisposes clients to psychic disorganization
An expression of intense anger or helplessness in order to block emotional pain
While shopping in a grocery store, a client with borderline personality disorder (BPD) greets the sibling of a neighbor with a great big hug. Then about 5 minutes later, the client walks past the sibling and ignores the sibling. The client is demonstrating what? Dichotomous thinking Affective instability Dissociation Identity diffusion
Affective instability
A client with a personality disorder is upset and calls the nurse a "stupid cow." Which is an effective initial response to this client's behavior? Discuss displacement of anger and set limits. Walk away from the client. Demonstrate empathy by reaching out to touch the client. Report the behavior to the health care provider so that consistency and consequences can be followed.
Discuss displacement of anger and set limits.
Which personality disorder is diagnosed more often in women? Histrionic Schizoid Antisocial Narcissistic
Histrionic
Which personality disorder is characterized by mistrust and suspiciousness of others? Histrionic Narcissistic Paranoid Dependent
Paranoid
A client on an inpatient psychiatric unit has features of borderline personality disorder. The client is frequently angry, has an unstable sense of self, and is highly impulsive. The client can be verbally abusive to staff, who feel manipulated by the client's behaviors. Which intervention does the nurse determine as priority? Social skills training Setting limits Stress management techniques Increased recreational therapy
Setting limits
